CLAIM
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Ensure your diagnosis matches the surgeon’s diagnosis.
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Ensure your CPT code matches the surgeon’s CPT code: 66984 for regular or 66982 for complex.
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Date of service is the “actual date of the surgery.”
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Box 33: Must contain the optometrist’s practice, not the surgeon's practice.
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Box 17: Insert the surgeon's name.
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Box 17B: Insert the surgeon's NPI#.
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Box 19: Type in the following words and actual dates; ASSUMED 00/00/0000; RELINQUISHED 00/00/0000 (This is the 90-day global period. Date Calculator.)
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Box 24G: (days or units) Medicare replacements and commercial insurances will only accept “1” unit and you bill for the total dollar amount of the co-management period.
- Initial Treatment Date, the Additional Claim Info tab must contain the date of surgery if the claim will be submitted electronically.
**Traditional Medicare (NGS) will only accept “90” units (or the actual number of days you co-managed the patient). In this situation, you would divide the number of days you co-managed the patient by your total co-management fee and bill that dollar amount as a “Per-day” amount. Your state's Medicare carrier may vary.
For example, you may bill one payer: Units = 1 & Fee = $300. And for Medicare you would bill: Units = 90 & Fee = $3.33
CODING
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1st eye CPT-66984 or 66982, then modifier LT or RT, then modifier 55 for co-management.
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2nd eye CPT-66984 or 66982 if during the 90-day global of the 1st eye then add LT or RT and both of the following modifiers: 55 for co-management and 79 for an unrelated procedure or service by same physician during post op care.
If the 90-day global period is over before billing the 2nd eye, or you are only billing for one eye, then it gets coded like the 1st eye example above.